#mentalhealth

The kids aren’t all right. Neither are staff.

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Good morning on R U OK? Day 2022. Today’s the perfect day to ask our higher education (HE) students how they are doing. According to the latest national 2021 Student Experience Survey (SES) released late last month, the answer is a depressing ’not so good’. The 2021 data again show that the top ranked reason for the 19% of undergraduate students in Australia who consider early departure from their course is ‘health or stress’. For those students who consider leaving, 50% say this is why. The next highest ranked reasons, also consistently reported over the last several years (2015-2021), are all risk factors that can combine to further exacerbate students’ health or stress: study/life balance; workload difficulties; need to do paid work; financial difficulties; expectations not met; and personal reasons. Students lead complex and complicated lives! 

While some might say that considering leaving is not the same as actual leaving, this somewhat misses the point. It is enough and concerning that so many students feel overwhelmed in this way and that their learning engagement and student experience are so obviously impacted as a consequence. These findings also confirm what we have known for many years. Tertiary students are a ‘very high-risk population for psychological distress and mental disorders’ compared to the general population. Pre-pandemic, the prevalence and severity of mental wellbeing issues were well-known and increasing across student cohorts. In 2017, Orygen found that more than half of HE students aged 16–25 years reported high or very high levels of psychological distress and were more likely to consider an early exit from their course as a result. The National Tertiary Student Wellbeing Survey (2016), conducted by Headspace for the National Union of Students, similarly found that:

  • 67% of young students (16-25 years) and 59% of mature students (26-50+ years) rated their mental health as ‘fair’ or ‘poor’;
  • 65% of young students and 53% of mature students reported high or very high psychological distress; and
  •  Only 1.6% of young students and 3.4% of mature students reported no impact of study on their mental health in the past year.

Certain cohorts have been identified as particularly at-risk, including equity group students who, given their frequent intersectionality, may experience compounded disadvantage. These cohorts include, for example, students who are: young; Indigenous; international; from rural/remote areas; identify as LGBTQIA+; with disability; from low socio-economic backgrounds; HDRs; and/or studying law and medicine.

And then along came COVID. Already high levels of student distress increased as many students felt overwhelmed, isolated and frustrated in the rapid transition to new ways of learning, working and living. For example, one study found that the percentage of HE and vocational education students reporting extremely high levels of distress during the pandemic (at 23%) was higher than before the pandemic (at 19%); considerably higher than for the general population at 3% pre-COVID and 13% during COVID. University counselling services that were already finding it difficult pre-COVID to meet escalating demands for support and struggling with increasing complexity and severity of presentations had to move completely online.

It’s not just situational and personal factors that affect students’ mental health. There is considerable evidence also that ‘how students are taught and assessed, and how they engage with learning, can have an impact on their wellbeing’. That evidence has been available both pre– and over-COVID, and some excellent resources have been developed in response (for example, Nicole Crawford’s NCSEHE Fellowship and the seminal work of Baik and her colleagues). Recently, a large-scale project in the UK has also focused on how curriculum can support wellbeing and learning, and has developed an Education for Mental Health Toolkit.

Not just student mental wellbeing

Academic and professional staff are also at risk, awareness of which has also been raised both pre– and over-COVID. In the UK, Morrish analysed data obtained under Freedom of Information requests of HE providers in a study that could be usefully replicated in Australia. She found:

  • Evidence of an escalation of poor mental health among university staff in the period 2009 to 2016, based on data obtained from 59 HE providers on referrals to counselling and occupational health services; and 
  • That referral increases of 50% were common over that period, with some universities experiencing much higher rises: in counselling, up to 316% and in occupational health up to 424%.

When updating these data in April 2020, Morrish and Priaulx found that ‘analysis of 17 universities reveals a continued rise in staff access to counselling and occupational health referrals’.

It is also reported that ‘responding to student mental health problems now appears to be an inevitable [though ambiguous] part of the role of an academic’, given their frontline, student-facing responsibilities. This has been found to negatively impact on the wellbeing of academics and requires universities to respond with clarity around role and boundary definition in this regard.  

‘Mental health and wellbeing’ in Australian higher education

Orygen defines ‘mental health and wellbeing’ as encompassing ‘the continuum of mental health states… Mental health includes both the presence and absence of mental ill-health, though it is more commonly associated with the presence of mental illness. Mental wellbeing is generally thought of as positive mental health’.

The Higher Education Standards Framework 2021 (HESF), against which all HE providers are regulated, specifically requires that adequate support for student mental health and wellbeing be provided (HESF Wellbeing and Safety: Standard 2.3.3). Also, the provider’s governing body must ‘develop and maintain an institutional environment in which …the wellbeing of students and staff is fostered’ (HESF Corporate Governance: Standard 6.1.4, emphasis added). The extent of regulatory oversight of these specific matters is unclear, though TEQSA has identified ‘wellbeing and safety of students’ (with no specific inclusion of staff) as one of its ‘compliance priorities for 2022’.  

In 2017, the Higher Education Standards Panel (HESP) recommended that ‘every institution should have an institution-wide mental health strategy and implementation plan’ (Recommendation 8). In 2020, the Productivity Commission’s Mental Health Inquiry Report recommended that the ‘accountability of tertiary education providers should be strengthened with expanded mental health support to their students, including international students’ (Recommendation 6). Like the HESP, the Productivity Commission recommended that all education providers should develop a student mental health and wellbeing strategy as a requirement of registration, urging also that data be collected nationally on support services’ use and that both vocational education and HE regulators monitor and collect evidence of interventions for ongoing improvement.

In 2020, with government funding provided in response to the 2017 HESP Report, Orygen produced the Australian University Mental Health Framework. It is unclear how many HE providers have adopted the Orygen framework as many had already developed their own response between 2017-2020, a number of which focus to a greater extent that Orygen’s on staff wellbeing. In 2022, there still appears to be no collection of national data as recommended by the Productivity Commission. 

What would ‘good’ look like for sector-wide HE mental wellbeing?

In the face of COVID-19’s exacerbation of existing mental health concerns, we need to up our game as a sector on how we support our student and staff wellbeing. It is fortunate that we are able to draw on some excellent international research and resources in this regard. In particular, the UK student mental health charity, Student Minds, led an 18 month, sector-wide consultation process with thousands of students and staff to produce The University Mental Health Charter (2019) which covers both students and staff and directs specific attention to learning, teaching and assessment. 

This work is complemented by Universities UK’s development of a strategic framework launched in 2017 and updated over COVID – Stepchange: mentally healthy universities – for a whole-of-institution, whole-of-sector approach that positions mental health as fundamental to HE’s core mission and foundational to university life for its students and staff. UUK has also developed an open-access self-assessment tool that maps onto the Charter. Completing the UK package of initiatives, The Wellbeing Thesis, hosted by Student Minds, provides resources to support and improve the mental health of postgraduate research students, while the Student Space website, again courtesy of Student Minds, offers an amazing array of tailored support for student cohorts who might face additional challenges with mental health at university. Collectively, this impressive cross-sectoral collaboration and alignment sets the international benchmark for sector-wide best practice. Australia seems some way behind in comparison. Churchill Fellowship scholar Dr Ben Veness has asked whether it is perhaps time for Australian universities to introduce an award or credentialing program for their mental health programs, such as that available in the UK and the US. 

But wait – there’s more! With the abrupt scaling on online delivery, digital well-being has also become a priority for all students and citizens. Jisc now incorporates ‘digital well-being’ as an element in its digital capability framework, defining it as

the impact of technologies and digital services on people’s mental, physical, social and emotional health. It is a complex concept that can be viewed from a variety of perspectives and across different contexts and situations.

Jisc has produced resources to support the digital well-being of staff and students: one for practitioners, with guidance and good practice principles, and another for senior leaders that articulates key issues and responsibilities and eight good practice principles for organisations. 

Foreseeable harm + regulatory requirement = HE duty of care 

The mental health and wellbeing of our sector’s students and staff have been on the radar (out from Under the Radar) for many years now. We know that harm is foreseeable. We should listen closely when another blip sounds a warning, as it did again last month via the SES data, and ask ourselves – what are we really doing about the intractable and ‘wicked problem’ of student (and staff) mental health and wellbeing?

Professor Sally Kift is a Principal Fellow of the Higher Education Academy (PFHEA), a Fellow of the Australian Academy of Law (FAAL), and President of the Australian Learning & Teaching Fellows (ALTF). She has held several university leadership positions, including as Deputy Vice-Chancellor (Academic) at James Cook University. Sally is a national Teaching Award winner, a national Program Award winner and a national Senior Teaching Fellow on the First Year Experience. In 2010, she was appointed an Australian Discipline Scholar in Law. In 2017, Sally received an Australian University Career Achievement Award for her contribution to Australian higher education. Since 2017, she has been working as an independent higher education consultant. @kiftsally 

Six factors that impact student mental health

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Young people attending university experience higher rates of stress, depression and anxiety than their peers who are primarily engaged in full or part-time work. What is going on here? And how can universities better support their students’ mental health?

I’ve been investigating the mental wellbeing of undergraduate and postgraduate students at The University of Melbourne since 2011.  Results from our most recent (pre-Covid-19) survey of the mental wellbeing of coursework students in eleven Bachelor and coursework Masters programs have just been published. Our study confirms many university students are struggling with mental health difficulties: more than 4,500 students responded to our anonymous, online survey and, of these, almost one-third reported ‘severe’ or ‘extremely severe’ levels of depressive symptoms, anxiety or (chronic) stress (as measured by the DASS-21). These symptom levels would impede students’ daily functioning (sleep, memory, cognitive processing), social interactions and learning. So there is definitely a problem.

What is going on here?

It seems that university study and university experiences are highly variable. For many, and even most, young people, university study affords positive experiences of personal and intellectual growth, exploration and achievement; university is a time and place for thriving. For some, however – around one in three in our study – their experiences are negative, and this appears to contribute to a spiral of stress, dis-engagement and mental health difficulties.

What can universities do about it?

Most universities are taking active steps to improve mental health services and information for their students and many now offer stress-management tools and strategies such as mindfulness. But such services are responsive, rather than preventive. My colleagues and I at the Melbourne Centre for the Study of Higher Education want to understand what university administrators and educators can do to ensure that more students thrive, not just survive, during their time at university. 

Our latest study identified six common course experiences that predict substantial variations in students’ levels of mental wellbeing. This is really important because it means that universities, and university teachers (academics) in particular, can do more to make a difference to student mental wellbeing than they, and others, might imagine.

But before explaining those course experiences, I need to first explain that we didn’t only consider course experiences. We all have lots of ideas about why university students might be experiencing high levels of stress and mental strain these days. For example, it’s widely discussed that the increasing costs involved in attending uni are putting many students under financial pressure. Most Australian uni students graduate with considerable Fee Help debts that may take decades to pay off and, in many disciplines, there is no guarantee – or even a reasonable prospect – that all graduates will find a job in their chosen field at the end of a degree. 

As a result, there’s pressure on uni students to do more than pass; they may need to graduate in the top X%, or to build a grade-point-average that is, ironically, ‘above average’ to secure a job. Such expectations might be particularly onerous for local students whose educational backgrounds haven’t prepared them for the styles of teaching and learning at university, those who speak English as an additional language, international/overseas students, those who are the first in their immediate family to attend a university, and so on.

We took stressors like these into account in our study. What we wanted to find out is: Do students’ course experiences – that universities can influence through curriculum design and teaching practices – predict mental wellbeing after students’ individual circumstances and backgrounds are taken into account? The short answer is, yes, they do. In fact, our study found that the six coursework experiences are stronger predictors of students’ mental health than demographic factors (such as age, gender, living situation, hours of paid work and family care per week etc) and individual stressors including financial stress, worry about job prospects or English language difficulties.

For example, in our statistical model of DASS-Depression, demographic factors accounted for 6% of variance in scores, individual stressors accounted for an additional 7%, while course experiences accounted for 16% (after taking all other factors into account). 

What this means is that ensuring that all students have positive course experiences can make a substantial difference to their mental wellbeing, notwithstanding common pressures on uni students, such as juggling family care and paid work commitments; financial strain; career uncertainty; or English language difficulties. 

Which course experiences predict students’ mental wellbeing? 

Course experiencesExample items
Sense of belonging (in the course, or to the university)‘I sometimes feel that I don’t belong here’
Assessment pressures‘When I work on assessment tasks I think about how poorly I am doing compared with other students’
Positive engagement with other students in the year/program/school‘I have made at least one or two close friendships with other students in my course’
Finding course content interesting or useful‘I’m really interested in what I’m studying’
Teachers perceived as supportive of students‘My teachers convey confidence in my ability to do well in the course’
Academic workload ‘The course workload is too heavy’

Feelings of not belonging and worry about assessments were most strongly predictive of both DASS-depressive and DASS-anxiety symptoms; while perceiving the course workload as unreasonable is independently associated with DASS-Stress. ‘Autonomous’ motivation for study – being interested or perceiving value in what you are studying – is strongly predictive of positive Psychological Wellbeing and Satisfaction with Life. Engagement with other students in the course is independently associated with all – positive and negative – mental health outcomes; while perceptions of Teacher Support are most strongly associated with DASS-Depression and Satisfaction With Life.

So. What can universities do to better support students’ mental wellbeing? Our findings suggest a twin focus – on (course)work and relationships. Rationalising and organising students’ academic workload will be helpful, as will ensuring that assessment tasks are well-spaced and designed to assess and promote learning, not only to normatively rank student performance (see, eg, Slavin, Schindler & Chibnall, 2014; Tang & Ferguson, 2014). Promoting respectful and accepting relationships among students and between staff and students is also vital if students are to form positive, rather than competitive, peer relationships (see Larcombe et al., 2013) and feel that they ‘belong’ within the program or university (van Gijn-Grosvenor & Huisman, 2020). The value of academic teachers showing interest in their students is difficult to over-state (Baik, Larcombe & Brooker, 2019). Our findings confirm previous studies that have found students thrive psychologically when teachers acknowledge their perspectives, offer meaningful choices and justify course requirements (see Su & Reeve, 2011). Student motivation for study is also known to be maintained when teachers support students to pursue their intrinsic interests and goals (Ryan & Deci, 2000), and when feedback on assessment is consistent and informative (Hoskins & Newstead, 2009). Recent research also suggests that students’ sense of belonging is strengthened when teachers value and respect all students’ contributions in class, and create welcoming and empathic learning environments (Wilson, Murray & Clarke, 2018; see also http://unistudentwellbeing.edu.au/).

Of course, there are already many pressures on curriculum designers and academic teachers. If supporting student mental wellbeing is to be added to, or elevated among, the list of priorities for academic teachers, they will need to be supported and resourced to explore evidence-based strategies and approaches. And those strategies and approaches in turn need appropriate resourcing. 

We hope that our research prompts university administrators and funders, not only university teachers, to think about how students’ course experiences might impact their mental health – both positively and negatively – and about the steps that can be taken to address students’ high levels of psychological distress. We have long known how much teachers matter for student learning; our study provides new insight into how much teachers and teaching practices matter to student wellbeing.

Dr Wendy Larcombe is a Principal Fellow at the Melbourne Centre for the Study of Higher Education and Melbourne Law School.